Healthcare Provider Details

I. General information

NPI: 1477240430
Provider Name (Legal Business Name): MARY-ELIZABETH VACHON LMSW, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 SAINT NICHOLAS AVE APT 7C
NEW YORK NY
10026-1239
US

IV. Provider business mailing address

191 SAINT NICHOLAS AVE APT 7C
NEW YORK NY
10026-1239
US

V. Phone/Fax

Practice location:
  • Phone: 917-558-2780
  • Fax:
Mailing address:
  • Phone: 917-558-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number068220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: